REFERRALS FOR REFERRING DOCTORS. PLEASE FILL PATIENT DETAILS BELOW Preferred Doctor*Dr Leo Pang Adult and paediatric Ear Nose and Throat Surgeon Head and Neck Surgeon, Thyroid and Parathyroid SurgeonDr Justin Kong Adult and paediatric Ear Nose and Throat Surgeon Sinus and nasal SurgeonFirst Available DoctorUrgent (suspected cancer referral)EarPain/InfectionDischargeHearing LossTinnitus/VertigoWaxOtherNoseSinusitisNasal ObstructionRhinorrhoeaSnoringLoss of smellOtherThroatDiscomfort/PainTonsillitisNeck massThyroidVoice/SwallowingOtherOther Ear SymptomOther Nose SymptomOther Throat SymptomPatient Name* First Last DOB* Date Format: MM slash DD slash YYYY Phone NumberReferrer Name*Referrer Clinic*Provider Number*Email* Comments